Center for Psychiatric Rehabilitation, Department of Occupational Therapy, Boston University, 940 Commonwealth Avenue, West, Boston, MA 02215, USA.
Schizophr Bull. 2013 May;39(3):658-72. doi: 10.1093/schbul/sbr203. Epub 2012 Jan 26.
Substance use disorders have a profound impact on the course of severe mental illnesses and on the family, but little research has evaluated the impact of family intervention for this population. To address this question, a randomized controlled trial was conducted comparing a brief (2-3 mo) Family Education (ED) program with a longer-term (9-18 mo) program that combined education with teaching communication and problem-solving skills, Family Intervention for Dual Disorders (FIDD). A total of 108 clients (77% schizophrenia-spectrum) and a key relative were randomized to either ED or FIDD and assessed at baseline and every 6 months for 3 years. Rates of retention of families in both programs were moderate. Intent-to-treat analyses indicated that clients in both programs improved in psychiatric, substance abuse, and functional outcomes, as did key relatives in knowledge of co-occurring disorders, burden, and mental health functioning. Clients in FIDD had significantly less severe overall psychiatric symptoms and psychotic symptoms and tended to improve more in functioning. Relatives in FIDD improved more in mental health functioning and knowledge of co-occurring disorders. There were no consistent differences between the programs in substance abuse severity or family burden. The findings support the utility of family intervention for co-occurring disorders, and the added benefits of communication and problem-solving training, but also suggest the need to modify these programs to retain more families in treatment in order to provide them with the information and skills they need to overcome the effects of these disorders.
物质使用障碍对严重精神疾病的病程和家庭有深远影响，但很少有研究评估针对该人群的家庭干预的影响。为了解决这个问题，进行了一项随机对照试验，比较了一个简短的（2-3 个月）家庭教育（ED）计划和一个更长期的（9-18 个月）计划，该计划将教育与教授沟通和解决问题的技能相结合，即双重障碍家庭干预（FIDD）。共有 108 名患者（77%为精神分裂症谱系）及其主要亲属被随机分配到 ED 或 FIDD 组，并在基线和 3 年内每 6 个月评估一次。两个方案中家庭的保留率都适中。意向治疗分析表明，两个方案中的患者在精神病、物质滥用和功能结局方面都有所改善，主要亲属在共病知识、负担和精神健康功能方面也有所改善。FIDD 组的患者总体精神病症状和精神病症状严重程度明显较轻，且功能改善趋势更为明显。FIDD 组的亲属在心理健康功能和共病知识方面的改善更为明显。两个方案在物质滥用严重程度或家庭负担方面没有一致的差异。这些发现支持了共病障碍的家庭干预的实用性，以及沟通和解决问题培训的附加益处，但也表明需要修改这些方案，以保留更多的家庭接受治疗，以便为他们提供克服这些障碍影响所需的信息和技能。
